April 9, 2025 • 22 mins
Every dentist dreads it: the day a case turns into a lawsuit. And often, it’s not the actual dentistry that gets you.
In this episode, Dr. Taher Dhoon gets candid about a worst-case scenario he’s facing in real time. He shares what mistakes opened the door to litigation, and the steps every dentist can take to avoid the same fate. You’ll learn best practices for case management, tools for documenting consent, and how to use the CANDOR process to resolve issues before they escalate.
Don’t wait for a lawsuit to test your systems — find out what to fix now!
Topics discussed in this episode:
- The missteps that lead to a lawsuit
- Why relationships and follow-ups matter
- When and how to initiate the CANDOR process
- Navigating the CANDOR process
- How to protect yourself from litigation
Get more information on the Colorado Surgical Institute:
https://www.coloradosurgicalinstitute.com/
For Taher's Informed Consent Forms mentioned in the episode. Click Here
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (00:02):
No matter how good you are, some cases just
don't go as planned, and whenthey don't, it can get messy
fast.
Today we got Dr Tahir Dune andhe's going to help you prepare
for what no one likes to talkabout how to protect yourself,
your patient and your practicefor when that unexpected thing
happens.
You'll hear important lessonsfrom a case that he's navigating
(00:22):
right now and find out whatsteps you can take to prevent a
complication from turning into aboard complaint or, worse, a
legal case.
This is going to be one thatyou're not going to want to miss
.
Pay attention, take some notes.
Let's get to it.
You are listening to DentalPractice Heroes, where we help
you create and scale your dentalpractice so that you are no
longer tied to the chair.
(00:43):
I'm Dr Paul Etcheson, author oftwo books on dental practice.
So that you are no longer tiedto the chair.
I'm Dr Paul Etcheson, author oftwo books on dental practice
management, dental coach andowner of a $6 million group
practice in the suburbs ofChicago.
I want to teach you how to growand systematize your dental
practice so you can spend lesstime practicing and more time
enjoying a life that you love.
Let's get started.
Hey, how's it going today?
(01:05):
Welcome back to the DentalPractice Heroes podcast.
I am joined by one of my goodfriends, dr Tahir Dune.
He is the founder and leadinstructor at Colorado Surgical
Institute Just a surgical genius, I like to call him.
He's the person I text when Ihave problems and he's been on
the podcast quite a few times.
So welcome back to here.
How's it going, man?
Taher Dhoon (01:26):
It's pretty good.
I mean dentistry wise fuckingcrushing it.
And then, from a homeperspective, we had a washer
just dump all this water on oursecond floor.
No, and it came through theceiling.
I was in the living room andlight water was dripping on my
shoulder from one of the lightsand I was like oh shit.
Paul Etchison (01:50):
I ran upstairs and it had dumped like I don't
know 10 gallons or somethingupstairs, and so we had the
floors torn up, and water is theworst Whenever it gets
somewhere it doesn't belong.
Taher Dhoon (01:54):
Yeah, and over the past 14 years this is like my
Achilles heel, I think I've hadlike six water incidences in all
the houses I've lived in over14 years, Like I've done
everything wrong with water manJeez, and maybe it's your diet,
maybe you're doing something tothe pipes.
Dude, it's Indian food.
I don't want to say it.
Paul Etchison (02:12):
I knew you didn't want to say it, but good old,
yeah.
So, dude, I love our topictoday.
We're going to talk about howto protect your practice.
I think I read somewhere thatin every dentist career we will
either have at least one boardcomplaint or one lawsuit.
I don't know what the exactstat is I have still yet to
experience mine, but damn, I'vegotten really close a lot of
(02:32):
times.
But we're going to talk aboutprotecting your practice against
things like that, becausenobody wants to go through
things like that and if you'veever talked to anyone who has,
even if they didn't settle orlose or just going through it,
it's not fun, I'm going throughit.
Taher Dhoon (02:45):
It's not fun.
I'm going through it right nowand it's all pretty fresh.
I actually met the patientyesterday and so I'll kind of go
through that story in a minute.
Yeah, but if you do surgery andyou do enough of really
anything, that's maybe biggercases crown and bridge cases,
endo cases, especially surgicalcases like wisdom teeth implants
, full arch it's kind of a boundto happen type of thing.
(03:05):
Lawyers are compensated 30 to40% of the settlement and they
get their fees covered also, andso the patients are just picked
up.
If the lawyer thinks that thisis a good case, they'll just
take the case to see if they canjust drag out a hundred grand
from you from a settlement orsomething like that.
So the case I'm going throughright now we did a bilateral
(03:29):
nerve reposition and in theconsent form it talks about
potential for a jaw fracture.
You know I did a repair case.
She had five implants.
I had to remove four of theimplants.
You know, graft everything,rebuild it all, move the nerves,
place new implants and sheended up fracturing the jaw
behind one of the distalimplants through the channel I
made to move the IAM.
You know the nerve and so it'sa common complication.
(03:52):
It was just a green stickfracture, which means it's just
a crack in the mandible, butit's not like a full compound
fracture where you know it's twoseparate pieces of bone.
Nonetheless, sent her to anoral surgeon.
Mistake number one I made was Isent her to an oral surgeon that
I didn't really have a goodrelationship with.
I didn't even know the guy, Ijust heard good things about him
, like hey, he really supportsGPs doing surgeries.
(04:13):
It's like okay, awesome.
Like I don't refer a lot ofsurgery out, I refer a lot of
perio, but I don't refer a lotof like all MFS, you know, like
plating and things like that.
So this guy didn't know me fromanyone, had a good conversation
and he did one surgery where heremoved one implant and then
plated the fracture.
From that perspective I waslike, okay, well, maybe he could
(04:33):
have just monitored it.
It's just a green stick, but atthe same time who's to kind of
quarterback his decision-makingprotocol?
But what he did after that is hedidn't let me know.
He ran a second surgery and hedidn't contact me.
He didn't ask for records Ihave 10 years of records on this
patient and he ended up makinga couple of mistakes because he
made assumptions about the caseand he removed all the implants,
(04:56):
all the grafting, crippled herbasically, and it's a shit show
at this point.
Like I had four really goodimplants in there, I could have
moved forward with her case.
We just had to, like you know,delay a couple of months and now
she's in the denture and nowshe needs like subperiosteal
implants and she's burnt out andshe's not going to do anything.
Yeah, and so it's really bad,right.
(05:18):
And so, at the end of the day,the areas where I wish I would
have done this differently are Ahave good relationships with
surgeons.
In my area.
If I'm being honest with myself, I haven't taken the time to
reach out to a lot of people andsay, hey, this is what I'm
doing and these are the things Ido on a common basis, and you
know, like, hey, like, let'shave a good relationship, and I
think that's important to have,because now they assume I'm a GP
(05:41):
who teaches GP surgery and Ihave a bad reputation because I
have Colorado Surgical Instituteand they don't actually know
what we're all about.
Number two is goodcommunication with the patient.
I handed out the patient, I hadgood communication, but then I
kind of didn't follow up a lot.
I was like, okay, she's in goodhands, all as well, so good
follow-up is going to beimportant too.
And then three is sending overthe specialist.
(06:04):
Even if they don't ask for areferral or any kind of
documentation, send themeverything.
Send them your treatment plan,send them like a synopsis, tell
them exactly what you plan ondoing, because I had a really
good game plan.
I had like four differentscenarios that I could have
taken her based on how shehealed, and he kind of screwed
them all up and I can't doanything.
Like my malpractice companysaid, you can't touch her
(06:24):
anymore.
Even if you wanted to, don'teven do it.
And me and her are close.
I mean, we're not that closeanymore, unfortunately, but we
were very close.
Paul Etchison (06:31):
Why is that?
What is the reason for themalpractice carrier telling you
just did that you can't do hercase ever again?
Taher Dhoon (06:37):
Because now I'm owning everything that the oral
surgeon did by doing her case.
Now I'm kind of absorbing allof that.
So I can't, because I have tobe able to say like I did not
ask for, that, I don't agreewith that treatment modality,
that he went and did and so Ican't treat her anymore.
So they're just like refer away.
Paul Etchison (06:55):
It's such a bad situation because it's almost
like not really the patient'sfault, not really your fault.
It's like a complication, butyet you center this place and it
sucks.
You know, going back to havinga relationship with your
specialist that you refer tolike this is something that I've
never personally I guess likeintentionally did.
But I have an oral surgeon thatI can talk to.
(07:18):
I've got an endodontist, I'vegot two orthodontists and I did
develop those.
But that was like right when Iopened, you know how they always
come into your office and likehey, we brought you cookies,
let's do lunch.
I'm like I want to do lunchwith you, you don't want to do
lunch with me.
I'm not that interesting.
How do you do this?
Like you mentioned, you haven'tbeen doing it and you haven't
made much of effort.
I mean, how would somebody goabout doing this and how do you
(07:39):
think you're going to do it?
Taher Dhoon (07:40):
I think the first step is is just kind of calling
around to your friends who areGPs in the area and finding out
like who's like a good person toapproach and then just dropping
them a line and saying, hey,you know, I'm trying to
implement more surgery in mypractice.
What I think that's going tomean is it's going to mean I'm
going to have more referrals tosend because I'm going to
understand.
I understand more now and Iunderstand more of what I want
(08:01):
to do and also what I don't wantto do.
And if you're someone who I cansend those things that I don't
want to do to, that's great.
And every once in a while, canI pick your brain?
I'd love to just ask youquestions from time to time,
keep it very noncommittal, butat the same time you're telling
them hey, I'm going to do somestuff and I'm going to be
relying on you for mentorship,and then the relationship grows
from there and and you'll findpeople who are really benevolent
(08:23):
and love to teach and help, andeven if they're specialists,
they like to help GPs.
And then you also have somepeople who actually just tell
you who they are and they'relike not interested.
Man like you shouldn't be doingthat and that's okay, right,
and then you know who to stayaway from.
So that's step one iscultivating a good group.
Step two is having a good groupof people you can call right
(08:43):
away, because when I saw thefracture in her x-ray, I called.
I had like a whole text list ofall the mentors who come and
teach at Colorado Surgical so Itexted them all and I had like
three phone calls in fiveminutes.
I had a group discussion onwhat to do while the patient was
in the chair.
So at the end of the day, it'sreally nice to have people you
(09:03):
can rely on.
There's something called thecandor process I want people to
know about.
So it's a new legal thing thatcame out where it's called
candor, where if you thinkthere's an adverse outcome
that's occurred, you as thephysician or doctor can initiate
the candor process, meaning youcontact malpractice and you say
(09:24):
, hey, there was an adverseoutcome, I want to get ahead of
this.
You have to initiate it beforethere's ever a demand made
official demand made by thepatient.
Then what happens is you guysmeet in some back room her
lawyer, your lawyer and you guysget to talk through the process
.
Everything said in that room isnot admissible in any court.
(09:45):
Any board conversation,anything, and you can actually
agree to a settlement value inthat one discussion.
Malpractice pays it and nothingis reportable to the National
Practitioner Data Bank.
Nothing is reportable to yourstate board.
Nothing is reportable at all.
It's all just swept under therug because you got ahead of the
curve.
So that's something that wetried to do in this situation.
(10:06):
Unfortunately, the patientdenied the Kandor process, but
nonetheless it was illuminatingfor me to even find out that it
existed as an option.
Paul Etchison (10:16):
We have complications all the time.
Is this, when you're sensingthis could litigate.
I feel like doing endo, bustinga file.
I'm not going to be like, okay,we've got to Kandor.
Now you know.
I'm going to be like, hey, goto the endonist and see if they
can get that out.
I mean, most of the time it'sstill at 01 and I'm just going
to operate right on top of it.
But when is it time for us tostart that process?
Taher Dhoon (10:37):
That's a tough question and because the thing
is, you got to get ahead of it.
So I would say more so than not.
I think if you did somethingwhere you're like you know what
I could have done better, Icould have done this better and
something happened, and even ifit was consented, and even if
you're dialed in or maybe hey,you got shitty notes or like oh
fuck, like I didn't get aconsent form on this and
(10:58):
something bad happened, dudecandor all day long.
Get ahead of this thing,because the lawyers will chew
you up in court if you don'thave rock-solid consent forms.
Paul Etchison (11:06):
So this is when you think you could possibly go
to court.
Taher Dhoon (11:08):
Correct, or if you're just like you know what I
made a mistake.
Right, I made a mistake.
Let's just get ahead of thisthing Like shit happens.
Paul Etchison (11:15):
Because I'm wondering, like with the cases
where I've had somecomplications and like, hey, you
know what?
This is not how we intended itto go, but this is how it went.
What do you want to do?
I'm happy to redo it, I'm happyto give your money back.
What do you think is fair?
And sometimes they say, yeah, Ijust want my money back to go
somewhere else and I go, okay,great.
Taher Dhoon (11:31):
Okay.
Paul Etchison (11:31):
I feel like I would prefer to do it that way
rather than go and meet and haveto do lunch with the patient
and their attorney.
Yeah, okay.
Taher Dhoon (11:40):
Awesome question.
So okay, if you can give themback what they paid in your
practice, you can have them signa form that just says, hey, I
won't sue you, you give them themoney back, all as well.
But if they ask for one pennymore than what they paid you,
that's when you would do candor,because if you do 1% more than
what they paid, the practiceit's viewed as a settlement, and
(12:03):
if it's a settlement it has tobe reportable, and then you have
to disclose it.
So at that point, that's whencandor is going to come in play,
when you think you need topotentially have more money
going to this person than whatthey actually paid for business
essentially.
Paul Etchison (12:16):
Wow, that's a good point to make.
I think that's really helpfulfor a lot of people to hear.
What else in this like, haveyou learned out of?
Taher Dhoon (12:22):
this situation.
So we all know the progressnotes like, do your notes?
I had a couple of notes that Idid a week later and the lawyers
didn't really care one way orthe other.
Just don't do it like 10 monthslater, don't change records at
all, have your consent formsigned and dated and everything
initialed on it.
So thank God, I was likebuttoned up on that and I had
mine saying hey, there's therisk of fracture, and it was
(12:43):
initialed and signed andeverything was clean on my end
for that.
So that's one of the mainreasons I'm not like overly
concerned about this case.
And then, when it really comesdown to it, what I've started
doing on cases over maybe like10 or 15,000, just depending on
whatever your personalpreferences is, you can do two
things.
You can get an AI transcriptionthing that just goes on the
back of your phone and it justlike transcribes both parties'
(13:06):
conversation and you just gothrough the consent form and you
talk about all the things andyou ask them if they have any
questions.
I just do it old school.
I just go on my phone into thevoice memo thing and I just
record it and I tell the patienthey, I'm going to record this
consent form.
It's a really long conversation.
I just want to make sure we'reboth very clear about
expectations on this one.
Now, I'm not doing this when Imeet the patient for the first
(13:31):
time, I'm getting caseacceptance the first time
without scaring the shit out ofthem, and I'm kind of talking
about benefits of the procedure.
And then when they come back infor their pre-surgical records,
then the second appointment isdesignated to scare them.
But also it's like it'sdelivering the message with
confidence and saying scarythings with confidence.
That actually is really.
(13:53):
It really makes the patientsfeel at ease and they're in the
right place.
Because you're someone who'sjust very comfortable with
saying, hey, you draw my breakand it's not going to happen,
and it's happened once in mycareer and at the same time,
like it's just something I wantyou to know about.
It's my job to make sure youknow these things, but also,
it's not gonna happen, I don'tthink you need to worry about it
.
Okay, there's just an offchance that it occurs.
So if you speak like that andyou're always cognizant like hey
(14:14):
, I'm recording thisconversation, this is getting
read back in a deposition.
They're gonna play in adeposition.
You know they're going to playthis in court.
I need this thing to be rocksolid.
Then you can have thatempathetic conversation but talk
about pros and cons of thesurgery and also, while you're
doing it, you have to talk aboutthe alternative treatment
options.
So I have a second case wherethe surgery was great.
(14:34):
It was six implants in themaxilla over five implants on
the mandible FP3, you're justregular all on four, all on X
approach.
But she came back to try to sueme because I didn't present the
FP1.
So the FP1, for those of youthat don't know is that like
three on six, it's likesegmented bridges on individual
implants type of deal.
And because I didn't have it inmy consent form that I didn't
(14:56):
present all her options to her,she tried to have a case against
me.
Now that was thrown out and itdidn't really.
But at the end of the day, weare hearing that if you don't
present all the treatmentoptions to patients and they're
not informed of what theiroptions are, that you could open
yourself up.
So it's one of those things,like you know with getting a tax
(15:17):
audit.
You know if you pay your kidsit's not a bad thing, but if you
pay your kids and have a homeoffice and have your car
deducted and deduct all yourclothes, well then, the IRS is
going to flag you.
So it's like it just dependshow many things add up when a
lawyer looks at the case.
Paul Etchison (15:31):
And if you don't have an informed consent like
signed, like even signed, likeyou're immediately dead.
That's what I've heard that theinformed consent won't save you
, but if it's not there, you'redead.
Taher Dhoon (15:40):
Correct, correct.
Yeah, I actually have this like.
We did a presentation on this Ithink it was something where
they looked at 52 cases and 40out of 52 cases there was no
written consent.
So when they go back and lookat this, you need a written
consent.
Verbal consent doesn't meancrap anymore.
It's good to have verbalconsent, but the video recording
(16:06):
is rock solid and then havingtheir signature and a dated rock
solid and I would advise anyoneto do that.
In any case, where you thinkit's complex and you can
re-remind them of like, hey, wedid talk about this because it's
not their job to remembereverything.
It's your job to explain it ina way that puts them at ease,
where they don't want to sue you.
Paul Etchison (16:22):
You know, I've never recorded a treatment
consent before and I think mostdocs listening are like, oh, I
have to record it.
Well, I'm not even doing it, myassistant just hands them a
form and they sign it.
But I would say there's nothingmore vindicating than when a
patient says we told themsomething on the phone and they
make a big stink about it and wesend them the phone recording
where they said what we reallysaid.
(16:42):
Like, oh man, I must havemisunderstood.
Like yeah, that's what I wassaying.
It feels so good.
Taher Dhoon (16:47):
Yeah, it really does.
It really does.
And here's the thing like weare right more times than they
are right, like this is what wedo every single day.
We say it every single day tothe patients and they just don't
remember, and it's really nottheir fault for not remembering.
Paul Etchison (17:01):
So going forward.
What are you personallychanging from going through this
process?
Taher Dhoon (17:06):
So the recordings are getting done on every
patient above $10,000 in myprivate practice.
The consent forms I justrewrote for all of them.
So there's a couple of likeone-liners in the consent forms
and I'm happy to share theconsent forms with everyone.
Is that I can just put that inthe show notes or something like
that?
Paul Etchison (17:23):
Paul, yeah, yeah, send me a link.
I'll put it in the show notes.
Taher Dhoon (17:25):
So we have a lot of good consent forms with
Colorado Surgical Institute, butI just redid the private
practice ones as well.
So we'll have like a couple ofdifferent ones you guys can pick
from.
Just remember change the name Ihad another doc having like me
getting consented in anotherstate.
So change the names.
Change all the logos, all thatstuff.
You guys are more than happy tohave you have them.
So update your consent form.
(17:47):
So a couple of one-liners inthere that I have are I give
doctor doing consent in thesurgery to do additional
procedures if needed, Because ifthey're sedated and you got to
wake them up, then explaineverything in a post-op, then
reschedule another surgery tojust fix the smallest thing in
the world.
Give me permission to do what Ineed to do according to my best
(18:11):
judgment.
I also put in there if theydon't follow the rules, there
are extra expenses associatedwith repairs and redoing the
procedure at full cost, and theysign and initial that one too.
So it's just like this wholething, like I don't fix stuff
for free.
I'll fix it for free if I wantto.
I'll fix it for free if you madeall your post-op appointments
and you did all the things youneed to do, but it's my choice
to do it for free and so thosetypes of things just put my mind
at ease because then I can begracious and I can give people
(18:33):
what I want to give them andhelp them.
But I don't have to be likeforced.
I hate being forced to dosomething, and if a patient
comes in with force and then I'mpainted into a corner because I
don't have documentation that'sprotecting me, it's the worst
feeling in the world.
You kind of feel like violatedat that point.
Paul Etchison (18:48):
There's so many things we can do in the practice
that we have patients sign, butthere's no discussion about it,
so it's irrelevant, it doesn'tmatter.
We do the same thing on ourtreatment platforms and says
this is just an estimate thatmost people have, this, you know
, and we want the patient tosign it, but my team knows it's
not.
Hey, this initial, this it's.
We're having a discussion.
Do you understand that, mrJones?
(19:11):
Yes, I do, you know, and itmakes it different if it ever
comes out 100%.
Taher Dhoon (19:13):
And one thing I like to put on the treatment
acceptance form where they signon the treatment they're
accepting, is a blurb at thebottom that says, for whatever
reason, if you owe a smallamount of money under $99 that
we'll, as a courtesy to you,we'll just bill your credit card
on file, so you don't have tohave someone on payroll going to
(19:34):
call them to collect $15because insurance underpaid a
little bit.
I just charge the card.
But I like having the signatureon that and we put it in the
treatment acceptance form.
Paul Etchison (19:43):
Yeah, we do the same thing as well with our
financial policies, and thatsaves us a lot of time, but we
still send them a statementsaying we're going to charge it
on this date, becauseoccasionally we get someone that
calls and says you can't dothat.
We say, well, where would youlike to pay it with?
It just works.
So, tahir, talk about ColoradoSurgical Institute and what you
guys provide for dentists.
Taher Dhoon (20:01):
Yeah, so at a very high level.
I mean you can come in and dolive patient surgeries.
We have a lot of videos andcurriculums we send out.
But lot of videos andcurriculums we send out.
But you can do wisdom teeth,single implants, lateral sinuses
, full arch digital workflow.
We have zygomas and pterygoidsand all the crazy stuff in
Brazil, so we really have a full, robust program.
We even can train dentalassistants to do phlebotomy and
(20:22):
sticky bone and all that prepwork and scanning.
We have a program forhygienists on implant
maintenance.
So really anything that youneed in this forum.
When it comes to anythingclinical, we're creating content
and having live patient coursesassociated with those as well.
Paul Etchison (20:37):
Awesome dude.
Thanks so much for coming on.
Dr Tahir Doon from ColoradoSurgical Institute, Go check out
their website,coloradosurgicalinstitutecom.
No matter how good you are, some cases just
don't go as planned, and whenthey don't, it can get messy
fast.
Today we got Dr Tahir Dune andhe's going to help you prepare
for what no one likes to talkabout how to protect yourself,
your patient and your practicefor when that unexpected thing
happens.
You'll hear important lessonsfrom a case that he's navigating
(00:22):
right now and find out whatsteps you can take to prevent a
complication from turning into aboard complaint or, worse, a
legal case.
This is going to be one thatyou're not going to want to miss
.
Pay attention, take some notes.
Let's get to it.
You are listening to DentalPractice Heroes, where we help
you create and scale your dentalpractice so that you are no
longer tied to the chair.
(00:43):
I'm Dr Paul Etcheson, author oftwo books on dental practice.
So that you are no longer tiedto the chair.
I'm Dr Paul Etcheson, author oftwo books on dental practice
management, dental coach andowner of a $6 million group
practice in the suburbs ofChicago.
I want to teach you how to growand systematize your dental
practice so you can spend lesstime practicing and more time
enjoying a life that you love.
Let's get started.
Hey, how's it going today?
(01:05):
Welcome back to the DentalPractice Heroes podcast.
I am joined by one of my goodfriends, dr Tahir Dune.
He is the founder and leadinstructor at Colorado Surgical
Institute Just a surgical genius, I like to call him.
He's the person I text when Ihave problems and he's been on
the podcast quite a few times.
So welcome back to here.
How's it going, man?
Taher Dhoon (01:26):
It's pretty good.
I mean dentistry wise fuckingcrushing it.
And then, from a homeperspective, we had a washer
just dump all this water on oursecond floor.
No, and it came through theceiling.
I was in the living room andlight water was dripping on my
shoulder from one of the lightsand I was like oh shit.
Paul Etchison (01:50):
I ran upstairs and it had dumped like I don't
know 10 gallons or somethingupstairs, and so we had the
floors torn up, and water is theworst Whenever it gets
somewhere it doesn't belong.
Taher Dhoon (01:54):
Yeah, and over the past 14 years this is like my
Achilles heel, I think I've hadlike six water incidences in all
the houses I've lived in over14 years, Like I've done
everything wrong with water manJeez, and maybe it's your diet,
maybe you're doing something tothe pipes.
Dude, it's Indian food.
I don't want to say it.
Paul Etchison (02:12):
I knew you didn't want to say it, but good old,
yeah.
So, dude, I love our topictoday.
We're going to talk about howto protect your practice.
I think I read somewhere thatin every dentist career we will
either have at least one boardcomplaint or one lawsuit.
I don't know what the exactstat is I have still yet to
experience mine, but damn, I'vegotten really close a lot of
(02:32):
times.
But we're going to talk aboutprotecting your practice against
things like that, becausenobody wants to go through
things like that and if you'veever talked to anyone who has,
even if they didn't settle orlose or just going through it,
it's not fun, I'm going throughit.
Taher Dhoon (02:45):
It's not fun.
I'm going through it right nowand it's all pretty fresh.
I actually met the patientyesterday and so I'll kind of go
through that story in a minute.
Yeah, but if you do surgery andyou do enough of really
anything, that's maybe biggercases crown and bridge cases,
endo cases, especially surgicalcases like wisdom teeth implants
, full arch it's kind of a boundto happen type of thing.
(03:05):
Lawyers are compensated 30 to40% of the settlement and they
get their fees covered also, andso the patients are just picked
up.
If the lawyer thinks that thisis a good case, they'll just
take the case to see if they canjust drag out a hundred grand
from you from a settlement orsomething like that.
So the case I'm going throughright now we did a bilateral
(03:29):
nerve reposition and in theconsent form it talks about
potential for a jaw fracture.
You know I did a repair case.
She had five implants.
I had to remove four of theimplants.
You know, graft everything,rebuild it all, move the nerves,
place new implants and sheended up fracturing the jaw
behind one of the distalimplants through the channel I
made to move the IAM.
You know the nerve and so it'sa common complication.
(03:52):
It was just a green stickfracture, which means it's just
a crack in the mandible, butit's not like a full compound
fracture where you know it's twoseparate pieces of bone.
Nonetheless, sent her to anoral surgeon.
Mistake number one I made was Isent her to an oral surgeon that
I didn't really have a goodrelationship with.
I didn't even know the guy, Ijust heard good things about him
, like hey, he really supportsGPs doing surgeries.
(04:13):
It's like okay, awesome.
Like I don't refer a lot ofsurgery out, I refer a lot of
perio, but I don't refer a lotof like all MFS, you know, like
plating and things like that.
So this guy didn't know me fromanyone, had a good conversation
and he did one surgery where heremoved one implant and then
plated the fracture.
From that perspective I waslike, okay, well, maybe he could
(04:33):
have just monitored it.
It's just a green stick, but atthe same time who's to kind of
quarterback his decision-makingprotocol?
But what he did after that is hedidn't let me know.
He ran a second surgery and hedidn't contact me.
He didn't ask for records Ihave 10 years of records on this
patient and he ended up makinga couple of mistakes because he
made assumptions about the caseand he removed all the implants,
(04:56):
all the grafting, crippled herbasically, and it's a shit show
at this point.
Like I had four really goodimplants in there, I could have
moved forward with her case.
We just had to, like you know,delay a couple of months and now
she's in the denture and nowshe needs like subperiosteal
implants and she's burnt out andshe's not going to do anything.
Yeah, and so it's really bad,right.
(05:18):
And so, at the end of the day,the areas where I wish I would
have done this differently are Ahave good relationships with
surgeons.
In my area.
If I'm being honest with myself, I haven't taken the time to
reach out to a lot of people andsay, hey, this is what I'm
doing and these are the things Ido on a common basis, and you
know, like, hey, like, let'shave a good relationship, and I
think that's important to have,because now they assume I'm a GP
(05:41):
who teaches GP surgery and Ihave a bad reputation because I
have Colorado Surgical Instituteand they don't actually know
what we're all about.
Number two is goodcommunication with the patient.
I handed out the patient, I hadgood communication, but then I
kind of didn't follow up a lot.
I was like, okay, she's in goodhands, all as well, so good
follow-up is going to beimportant too.
And then three is sending overthe specialist.
(06:04):
Even if they don't ask for areferral or any kind of
documentation, send themeverything.
Send them your treatment plan,send them like a synopsis, tell
them exactly what you plan ondoing, because I had a really
good game plan.
I had like four differentscenarios that I could have
taken her based on how shehealed, and he kind of screwed
them all up and I can't doanything.
Like my malpractice companysaid, you can't touch her
(06:24):
anymore.
Even if you wanted to, don'teven do it.
And me and her are close.
I mean, we're not that closeanymore, unfortunately, but we
were very close.
Paul Etchison (06:31):
Why is that?
What is the reason for themalpractice carrier telling you
just did that you can't do hercase ever again?
Taher Dhoon (06:37):
Because now I'm owning everything that the oral
surgeon did by doing her case.
Now I'm kind of absorbing allof that.
So I can't, because I have tobe able to say like I did not
ask for, that, I don't agreewith that treatment modality,
that he went and did and so Ican't treat her anymore.
So they're just like refer away.
Paul Etchison (06:55):
It's such a bad situation because it's almost
like not really the patient'sfault, not really your fault.
It's like a complication, butyet you center this place and it
sucks.
You know, going back to havinga relationship with your
specialist that you refer tolike this is something that I've
never personally I guess likeintentionally did.
But I have an oral surgeon thatI can talk to.
(07:18):
I've got an endodontist, I'vegot two orthodontists and I did
develop those.
But that was like right when Iopened, you know how they always
come into your office and likehey, we brought you cookies,
let's do lunch.
I'm like I want to do lunchwith you, you don't want to do
lunch with me.
I'm not that interesting.
How do you do this?
Like you mentioned, you haven'tbeen doing it and you haven't
made much of effort.
I mean, how would somebody goabout doing this and how do you
(07:39):
think you're going to do it?
Taher Dhoon (07:40):
I think the first step is is just kind of calling
around to your friends who areGPs in the area and finding out
like who's like a good person toapproach and then just dropping
them a line and saying, hey,you know, I'm trying to
implement more surgery in mypractice.
What I think that's going tomean is it's going to mean I'm
going to have more referrals tosend because I'm going to
understand.
I understand more now and Iunderstand more of what I want
(08:01):
to do and also what I don't wantto do.
And if you're someone who I cansend those things that I don't
want to do to, that's great.
And every once in a while, canI pick your brain?
I'd love to just ask youquestions from time to time,
keep it very noncommittal, butat the same time you're telling
them hey, I'm going to do somestuff and I'm going to be
relying on you for mentorship,and then the relationship grows
from there and and you'll findpeople who are really benevolent
(08:23):
and love to teach and help, andeven if they're specialists,
they like to help GPs.
And then you also have somepeople who actually just tell
you who they are and they'relike not interested.
Man like you shouldn't be doingthat and that's okay, right,
and then you know who to stayaway from.
So that's step one iscultivating a good group.
Step two is having a good groupof people you can call right
(08:43):
away, because when I saw thefracture in her x-ray, I called.
I had like a whole text list ofall the mentors who come and
teach at Colorado Surgical so Itexted them all and I had like
three phone calls in fiveminutes.
I had a group discussion onwhat to do while the patient was
in the chair.
So at the end of the day, it'sreally nice to have people you
(09:03):
can rely on.
There's something called thecandor process I want people to
know about.
So it's a new legal thing thatcame out where it's called
candor, where if you thinkthere's an adverse outcome
that's occurred, you as thephysician or doctor can initiate
the candor process, meaning youcontact malpractice and you say
(09:24):
, hey, there was an adverseoutcome, I want to get ahead of
this.
You have to initiate it beforethere's ever a demand made
official demand made by thepatient.
Then what happens is you guysmeet in some back room her
lawyer, your lawyer and you guysget to talk through the process
.
Everything said in that room isnot admissible in any court.
(09:45):
Any board conversation,anything, and you can actually
agree to a settlement value inthat one discussion.
Malpractice pays it and nothingis reportable to the National
Practitioner Data Bank.
Nothing is reportable to yourstate board.
Nothing is reportable at all.
It's all just swept under therug because you got ahead of the
curve.
So that's something that wetried to do in this situation.
(10:06):
Unfortunately, the patientdenied the Kandor process, but
nonetheless it was illuminatingfor me to even find out that it
existed as an option.
Paul Etchison (10:16):
We have complications all the time.
Is this, when you're sensingthis could litigate.
I feel like doing endo, bustinga file.
I'm not going to be like, okay,we've got to Kandor.
Now you know.
I'm going to be like, hey, goto the endonist and see if they
can get that out.
I mean, most of the time it'sstill at 01 and I'm just going
to operate right on top of it.
But when is it time for us tostart that process?
Taher Dhoon (10:37):
That's a tough question and because the thing
is, you got to get ahead of it.
So I would say more so than not.
I think if you did somethingwhere you're like you know what
I could have done better, Icould have done this better and
something happened, and even ifit was consented, and even if
you're dialed in or maybe hey,you got shitty notes or like oh
fuck, like I didn't get aconsent form on this and
(10:58):
something bad happened, dudecandor all day long.
Get ahead of this thing,because the lawyers will chew
you up in court if you don'thave rock-solid consent forms.
Paul Etchison (11:06):
So this is when you think you could possibly go
to court.
Taher Dhoon (11:08):
Correct, or if you're just like you know what I
made a mistake.
Right, I made a mistake.
Let's just get ahead of thisthing Like shit happens.
Paul Etchison (11:15):
Because I'm wondering, like with the cases
where I've had somecomplications and like, hey, you
know what?
This is not how we intended itto go, but this is how it went.
What do you want to do?
I'm happy to redo it, I'm happyto give your money back.
What do you think is fair?
And sometimes they say, yeah, Ijust want my money back to go
somewhere else and I go, okay,great.
Taher Dhoon (11:31):
Okay.
Paul Etchison (11:31):
I feel like I would prefer to do it that way
rather than go and meet and haveto do lunch with the patient
and their attorney.
Yeah, okay.
Taher Dhoon (11:40):
Awesome question.
So okay, if you can give themback what they paid in your
practice, you can have them signa form that just says, hey, I
won't sue you, you give them themoney back, all as well.
But if they ask for one pennymore than what they paid you,
that's when you would do candor,because if you do 1% more than
what they paid, the practiceit's viewed as a settlement, and
(12:03):
if it's a settlement it has tobe reportable, and then you have
to disclose it.
So at that point, that's whencandor is going to come in play,
when you think you need topotentially have more money
going to this person than whatthey actually paid for business
essentially.
Paul Etchison (12:16):
Wow, that's a good point to make.
I think that's really helpfulfor a lot of people to hear.
What else in this like, haveyou learned out of?
Taher Dhoon (12:22):
this situation.
So we all know the progressnotes like, do your notes?
I had a couple of notes that Idid a week later and the lawyers
didn't really care one way orthe other.
Just don't do it like 10 monthslater, don't change records at
all, have your consent formsigned and dated and everything
initialed on it.
So thank God, I was likebuttoned up on that and I had
mine saying hey, there's therisk of fracture, and it was
(12:43):
initialed and signed andeverything was clean on my end
for that.
So that's one of the mainreasons I'm not like overly
concerned about this case.
And then, when it really comesdown to it, what I've started
doing on cases over maybe like10 or 15,000, just depending on
whatever your personalpreferences is, you can do two
things.
You can get an AI transcriptionthing that just goes on the
back of your phone and it justlike transcribes both parties'
(13:06):
conversation and you just gothrough the consent form and you
talk about all the things andyou ask them if they have any
questions.
I just do it old school.
I just go on my phone into thevoice memo thing and I just
record it and I tell the patienthey, I'm going to record this
consent form.
It's a really long conversation.
I just want to make sure we'reboth very clear about
expectations on this one.
Now, I'm not doing this when Imeet the patient for the first
(13:31):
time, I'm getting caseacceptance the first time
without scaring the shit out ofthem, and I'm kind of talking
about benefits of the procedure.
And then when they come back infor their pre-surgical records,
then the second appointment isdesignated to scare them.
But also it's like it'sdelivering the message with
confidence and saying scarythings with confidence.
That actually is really.
(13:53):
It really makes the patientsfeel at ease and they're in the
right place.
Because you're someone who'sjust very comfortable with
saying, hey, you draw my breakand it's not going to happen,
and it's happened once in mycareer and at the same time,
like it's just something I wantyou to know about.
It's my job to make sure youknow these things, but also,
it's not gonna happen, I don'tthink you need to worry about it
.
Okay, there's just an offchance that it occurs.
So if you speak like that andyou're always cognizant like hey
(14:14):
, I'm recording thisconversation, this is getting
read back in a deposition.
They're gonna play in adeposition.
You know they're going to playthis in court.
I need this thing to be rocksolid.
Then you can have thatempathetic conversation but talk
about pros and cons of thesurgery and also, while you're
doing it, you have to talk aboutthe alternative treatment
options.
So I have a second case wherethe surgery was great.
(14:34):
It was six implants in themaxilla over five implants on
the mandible FP3, you're justregular all on four, all on X
approach.
But she came back to try to sueme because I didn't present the
FP1.
So the FP1, for those of youthat don't know is that like
three on six, it's likesegmented bridges on individual
implants type of deal.
And because I didn't have it inmy consent form that I didn't
(14:56):
present all her options to her,she tried to have a case against
me.
Now that was thrown out and itdidn't really.
But at the end of the day, weare hearing that if you don't
present all the treatmentoptions to patients and they're
not informed of what theiroptions are, that you could open
yourself up.
So it's one of those things,like you know with getting a tax
(15:17):
audit.
You know if you pay your kidsit's not a bad thing, but if you
pay your kids and have a homeoffice and have your car
deducted and deduct all yourclothes, well then, the IRS is
going to flag you.
So it's like it just dependshow many things add up when a
lawyer looks at the case.
Paul Etchison (15:31):
And if you don't have an informed consent like
signed, like even signed, likeyou're immediately dead.
That's what I've heard that theinformed consent won't save you
, but if it's not there, you'redead.
Taher Dhoon (15:40):
Correct, correct.
Yeah, I actually have this like.
We did a presentation on this Ithink it was something where
they looked at 52 cases and 40out of 52 cases there was no
written consent.
So when they go back and lookat this, you need a written
consent.
Verbal consent doesn't meancrap anymore.
It's good to have verbalconsent, but the video recording
(16:06):
is rock solid and then havingtheir signature and a dated rock
solid and I would advise anyoneto do that.
In any case, where you thinkit's complex and you can
re-remind them of like, hey, wedid talk about this because it's
not their job to remembereverything.
It's your job to explain it ina way that puts them at ease,
where they don't want to sue you.
Paul Etchison (16:22):
You know, I've never recorded a treatment
consent before and I think mostdocs listening are like, oh, I
have to record it.
Well, I'm not even doing it, myassistant just hands them a
form and they sign it.
But I would say there's nothingmore vindicating than when a
patient says we told themsomething on the phone and they
make a big stink about it and wesend them the phone recording
where they said what we reallysaid.
(16:42):
Like, oh man, I must havemisunderstood.
Like yeah, that's what I wassaying.
It feels so good.
Taher Dhoon (16:47):
Yeah, it really does.
It really does.
And here's the thing like weare right more times than they
are right, like this is what wedo every single day.
We say it every single day tothe patients and they just don't
remember, and it's really nottheir fault for not remembering.
Paul Etchison (17:01):
So going forward.
What are you personallychanging from going through this
process?
Taher Dhoon (17:06):
So the recordings are getting done on every
patient above $10,000 in myprivate practice.
The consent forms I justrewrote for all of them.
So there's a couple of likeone-liners in the consent forms
and I'm happy to share theconsent forms with everyone.
Is that I can just put that inthe show notes or something like
that?
Paul Etchison (17:23):
Paul, yeah, yeah, send me a link.
I'll put it in the show notes.
Taher Dhoon (17:25):
So we have a lot of good consent forms with
Colorado Surgical Institute, butI just redid the private
practice ones as well.
So we'll have like a couple ofdifferent ones you guys can pick
from.
Just remember change the name Ihad another doc having like me
getting consented in anotherstate.
So change the names.
Change all the logos, all thatstuff.
You guys are more than happy tohave you have them.
So update your consent form.
(17:47):
So a couple of one-liners inthere that I have are I give
doctor doing consent in thesurgery to do additional
procedures if needed, Because ifthey're sedated and you got to
wake them up, then explaineverything in a post-op, then
reschedule another surgery tojust fix the smallest thing in
the world.
Give me permission to do what Ineed to do according to my best
(18:11):
judgment.
I also put in there if theydon't follow the rules, there
are extra expenses associatedwith repairs and redoing the
procedure at full cost, and theysign and initial that one too.
So it's just like this wholething, like I don't fix stuff
for free.
I'll fix it for free if I wantto.
I'll fix it for free if you madeall your post-op appointments
and you did all the things youneed to do, but it's my choice
to do it for free and so thosetypes of things just put my mind
at ease because then I can begracious and I can give people
(18:33):
what I want to give them andhelp them.
But I don't have to be likeforced.
I hate being forced to dosomething, and if a patient
comes in with force and then I'mpainted into a corner because I
don't have documentation that'sprotecting me, it's the worst
feeling in the world.
You kind of feel like violatedat that point.
Paul Etchison (18:48):
There's so many things we can do in the practice
that we have patients sign, butthere's no discussion about it,
so it's irrelevant, it doesn'tmatter.
We do the same thing on ourtreatment platforms and says
this is just an estimate thatmost people have, this, you know
, and we want the patient tosign it, but my team knows it's
not.
Hey, this initial, this it's.
We're having a discussion.
Do you understand that, mrJones?
(19:11):
Yes, I do, you know, and itmakes it different if it ever
comes out 100%.
Taher Dhoon (19:13):
And one thing I like to put on the treatment
acceptance form where they signon the treatment they're
accepting, is a blurb at thebottom that says, for whatever
reason, if you owe a smallamount of money under $99 that
we'll, as a courtesy to you,we'll just bill your credit card
on file, so you don't have tohave someone on payroll going to
(19:34):
call them to collect $15because insurance underpaid a
little bit.
I just charge the card.
But I like having the signatureon that and we put it in the
treatment acceptance form.
Paul Etchison (19:43):
Yeah, we do the same thing as well with our
financial policies, and thatsaves us a lot of time, but we
still send them a statementsaying we're going to charge it
on this date, becauseoccasionally we get someone that
calls and says you can't dothat.
We say, well, where would youlike to pay it with?
It just works.
So, tahir, talk about ColoradoSurgical Institute and what you
guys provide for dentists.
Taher Dhoon (20:01):
Yeah, so at a very high level.
I mean you can come in and dolive patient surgeries.
We have a lot of videos andcurriculums we send out.
But lot of videos andcurriculums we send out.
But you can do wisdom teeth,single implants, lateral sinuses
, full arch digital workflow.
We have zygomas and pterygoidsand all the crazy stuff in
Brazil, so we really have a full, robust program.
We even can train dentalassistants to do phlebotomy and
(20:22):
sticky bone and all that prepwork and scanning.
We have a program forhygienists on implant
maintenance.
So really anything that youneed in this forum.
When it comes to anythingclinical, we're creating content
and having live patient coursesassociated with those as well.
Paul Etchison (20:37):
Awesome dude.
Thanks so much for coming on.
Dr Tahir Doon from ColoradoSurgical Institute, Go check out
their website,coloradosurgicalinstitutecom.
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